1. Articles from Niels Ramsing Holm

    1-18 of 18
    1. Optical coherence tomography in coronary atherosclerosis assessment and intervention

      Optical coherence tomography in coronary atherosclerosis assessment and intervention

      Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing ...

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    2. A randomized clinical study using optical coherence tomography to evaluate the short-term effects of high-intensity interval training on cardiac allograft vasculopathy: a HITTS substudy

      A randomized clinical study using optical coherence tomography to evaluate the short-term effects of high-intensity interval training on cardiac allograft vasculopathy: a HITTS substudy

      Cardiac allograft vasculopathy (CAV) remains a leading cause of long-term mortality after heart transplantation. Both preventive measures and treatment options are limited. This study aimed to evaluate the short-term effects of high-intensity interval training (HIT) on CAV in de novo heart transplant (HTx) recipients as assessed by optical coherence tomography (OCT). The study population was a subgroup of the 81-patient HITTS study in which HTx recipients were randomized to HIT or moderate intensity continuous training (MICT) for nine consecutive months. OCT images from baseline and 12 months were compared to assess CAV progression. The primary endpoint was defined as the ...

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    3. Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation

      Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation

      Fractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance of epicardial coronary stenosis. Despite the overall trend towards more physiology-guided revascularization, there remains a gap between guideline recommendations and the clinical adoption of functional evaluation of stenosis severity. A number of image-based approaches have been proposed to compute FFR without the use of pressure wire and induced hyperaemia. In order to better understand these emerging technologies, we sought to highlight the principles, diagnostic performance, clinical applications, practical aspects, and current challenges of computational physiology in the catheterization laboratory ...

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    4. Mechanical performance and healing patterns of the novel sirolimus-eluting bioresorbable Fantom scaffold: 6-month and 9-month follow-up by optical coherence tomography in the FANTOM II study

      Mechanical performance and healing patterns of the novel sirolimus-eluting bioresorbable Fantom scaffold: 6-month and 9-month follow-up by optical coherence tomography in the FANTOM II study

      Objectives We aimed to evaluate the mechanical properties and healing patterns 6 and 9 months after implantation of the sirolimus-eluting Fantom bioresorbable scaffold (BRS). Background The Fantom BRS (Reva Medical, San Diego, USA) has differentiating properties including radiopacity, strut thickness of 125 µm, high expansion capacity and has demonstrated favourable mid-term clinical and angiographic outcomes. Methods and results FANTOM II was a prospective, single arm study with implantation of the Fantom BRS in 240 patients with stable angina pectoris. Guidance by optical coherence tomography (OCT) was encouraged and was repeated at 6-month (cohort A) or 9-month follow-up (cohort B). Matched ...

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    5. Rational and Design of the European Randomized Optical Coherence Tomography Optimized Bifurcation Event Reduction Trial (OCTOBER)

      Rational and Design of the European Randomized Optical Coherence Tomography Optimized Bifurcation Event Reduction Trial (OCTOBER)

      Background Percutaneous coronary intervention (PCI) in complex bifurcation lesions is prone to suboptimal implantation results and is associated with increased risk of subsequent clinical events. Angiographic ambiguity is high during bifurcation stenting but it is unknown if procedural guidance by intravascular optical coherence tomography (OCT) improves clinical outcome. Methods and design OCTOBER is a randomized, investigator initiated, multi-center trial aimed to show superiority of OCT guided stent implantation compared to standard angiographic guided implantation in bifurcation lesions. The primary outcome measure is a two-year composite endpoint of cardiac death, target lesion myocardial infarction, and ischemia driven target lesion revascularization. The ...

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    6. Detection of early changes in the coronary artery microstructure after heart transplantation: A prospective optical coherence tomography study

      Detection of early changes in the coronary artery microstructure after heart transplantation: A prospective optical coherence tomography study

      Objectives To describe and characterize changes in the coronary artery microstructure during the first year following heart transplantation (HTx) by serial optical coherence tomography (OCT) scans. Background OCT enables in-vivo cardiac allograft vasculopathy (CAV) microstructure characterization. Early coronary artery microstructure changes after HTx may provide important mechanistic information regarding CAV development. Methods Twenty-six patients were enrolled at routine baseline coronary angiography 3 months after HTx. Coronary OCT scans were performed in all three major vessels at baseline and were repeated 12 months after HTx. We contoured the vessel layers for absolute and relative measurements. Lipid plaques, calcified plaques, layered fibrotic ...

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    7. Layered Fibrotic Plaques Are the Predominant Component in Cardiac Allograft Vasculopathy

      Layered Fibrotic Plaques Are the Predominant Component in Cardiac Allograft Vasculopathy

      Objectives The aims of this study were to characterize cardiac allograft vasculopathy (CAV) phenotypes using optical coherence tomography (OCT) and to evaluate the prognostic significance of OCT-determined CAV severity. Background Intravascular OCT enables in vivo characterization of CAV microstructure after heart transplantation. Methods Sixty-two patients undergoing heart transplantation were enrolled at routine angiography from September 2013 through October 2015 and prospectively followed until censoring on May 27, 2016. Optical coherence tomographic acquisitions aimed for the longest possible pull-backs, including proximal segments of all 3 major vessels. Plaques and bright spots were analyzed by delineating circumferential borders and measuring the angulation ...

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    8. ST Elevation Infarction after Heart Transplantation Induced by Coronary Spasms and Mural Thrombus Detected by Optical Coherence Tomography

      ST Elevation Infarction after Heart Transplantation Induced by Coronary Spasms and Mural Thrombus Detected by Optical Coherence Tomography

      The case illustrates the possible link between coronary spasms, intraluminal thrombus formation, and widespread organized and layered thrombi in HTx patients. Furthermore, the case underlines the clinical value of OCT as a novel method for high-resolution vessel imaging in heart-transplanted (HTx) patients with coronary spasms and suspected coronary artery disease. Coronary spasms and sudden death are frequent complications after HTx. The underlying mechanisms leading to these complications are unknown. The present case displays the clinical course of a 19-year-old HTx patient who was hospitalized due to acute myocardial infarction induced by severe coronary spasms. The patients remained unstable on conservative ...

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    9. Inducing Persistent Flow Disturbances Accelerates Atherogenesis and Promotes Thin Cap Fibroatheroma Development in D374Y-PCSK9 Hypercholesterolemic Minipigs

      Inducing Persistent Flow Disturbances Accelerates Atherogenesis and Promotes Thin Cap Fibroatheroma Development in D374Y-PCSK9 Hypercholesterolemic Minipigs

      Background— Although disturbed flow is thought to play a central role in the development of advanced coronary atherosclerotic plaques, no causal relationship has been established. We evaluated whether inducing disturbed flow would cause the development of advanced coronary plaques, including thin cap fibroatheroma. Methods and Results— D374Y -PCSK9 hypercholesterolemic minipigs (n=5) were instrumented with an intracoronary shear-modifying stent (SMS). Frequency-domain optical coherence tomography was obtained at baseline, immediately poststent, 19 weeks, and 34 weeks, and used to compute shear stress metrics of disturbed flow. At 34 weeks, plaque type was assessed within serially collected histological sections and coregistered to ...

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    10. Stent collapse after guide extension catheter collision. Signature procedural finding by optical coherence tomography

      Stent collapse after guide extension catheter collision. Signature procedural finding by optical coherence tomography

      Excessive deformation of stents can lead to strut fracture and subsequent stent collapse. Procedural damages to the stent are rarely visible by angiography during implantation but may be detected by OCT. Here we present a case with a subtle but signature finding by OCT indicative of stent fracture.

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    11. Uncertain Detection of Nonuniform Scaffold Expansion Patterns Using Optical Coherence Tomography

      Uncertain Detection of Nonuniform Scaffold Expansion Patterns Using Optical Coherence Tomography

      We read with interest the paper by Ohno et al. ( (1) ) and found that their conclusions merit a few comments. Longitudinal nonuniform expansion patterns by the ABSORB bioresorbable scaffold (BVS) (Abbott Vascular, Irvine, California) may be of clinical importance, but the use of optical coherence tomography (OCT) to identify such patterns requires methods that take catheter motion artifacts into account. The variation in length measurements by OCT compared with nominal length has been reported in ABSORB BVS–treated patients with differences of as much as 5.2 mm ( (2) ) and as much as 10 mm in metal stent–treated patients ...

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    12. OCT for bifurcation stenting: what have we learned?

      OCT for bifurcation stenting: what have we learned?

      Treatment of bifurcation lesions by percutaneous coronary intervention (PCI) shows major variation in complexity. Intravascular optical coherence tomography (OCT) provides high-resolution images of the pathoanatomy, thrombus, wires and stent positions during the procedure. This information may prove crucial in optimising PCI results and clinical outcomes after complex bifurcation treatment. Mounting evidence confirms the feasibility of OCT in bifurcations, and specific steps where OCT may be advantageous in guiding bifurcation PCI have been identified. Awaiting major clinical outcome trials, OCT has already entered the European guidelines for myocardial revascularisation. This paper aims to provide an overview of the potential clinical use ...

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    13. Co-registration of Optical Coherence Tomography and X-ray Angiography in Percutaneous Coronary Intervention. The Does Optical Coherence Tomography Optimize Revascularization (DOCTOR) Fusion Study

      Co-registration of Optical Coherence Tomography and X-ray Angiography in Percutaneous Coronary Intervention. The Does Optical Coherence Tomography Optimize Revascularization (DOCTOR) Fusion Study

      Background Intracoronary imaging provides accurate lesion delineation and precise measurements for sizing and positioning of coronary stents. During percutaneous coronary intervention (PCI), it may be challenging to identify corresponding segments between intracoronary imaging and angiography. Computer based online co-registration may aid the target segment identification. Methods The DOCTOR Fusion study was a prospective, single arm, observational study including patients admitted for elective PCI. Optical coherence tomography (OCT) was acquired pre-stent implantation for sizing of stents. The operator subsequently indicated on the angiogram the target area as identified by OCT. Computer based co-registration was performed on-line immediately after pre-stent acquisition to ...

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    14. Left Main Coronary Artery Lesions and Optical Coherence Tomography

      Left Main Coronary Artery Lesions and Optical Coherence Tomography

      Optimal treatment of left main coronary artery (LMCA) lesions requires a highly tailored approach that incorporates patient comorbidities, clinical presentation, the extent of coronary artery disease (CAD), lesion characteristics and local expertise. 1,2 Coronary artery bypass grafting (CABG) is the treatment for LMCA lesions that has the highest evidence level in guideline recommendations. 2,3 However, the evidence for percutaneous coronary intervention (PCI) has increased in recent years and is now class IIa for ostial and trunk LMCA lesions and IIb for distal LMCA bifurcation treatment in stable patients suited for PCI. 2,3 However, these lesion-specific recommendations cannot ...

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      Mentions: Abbott
    15. Serial optical frequency domain imaging in STEMI patients: the follow-up report of TROFI study

      Serial optical frequency domain imaging in STEMI patients: the follow-up report of TROFI study

      Aims To investigate the incidence of incomplete stent apposition and to explore the impact of the presence of thrombus and protruding plaque after stent implantation on neointima formation at follow-up in ST-segment elevation myocardial infarction (STEMI) patients with serial optical frequency domain imaging (OFDI) investigations. Methods and results In a multi-centre study, 141 patients with ST elevation myocardial infarction <12 h from onset were randomized to either PPCI with thrombectomy (TB) using an Eliminate catheter (TB: n = 71) or without TB (non-TB: n = 70). OFDI after drug-eluting stenting was performed using TERUMO OFDI system. Per protocol, at follow-up 49 patients ...

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    16. Clinical use of Optical Coherence Tomography to identify angiographic silent stent thrombosis

      Clinical use of Optical Coherence Tomography to identify angiographic silent stent thrombosis

      Objectives: Patients previously treated with coronary stents may suffer an acute coronary syndrome (ACS) without any evidence of thrombus formation on coronary angiography (CAG). This may be due to partial, non-occlusive stent thrombosis with microembolization. In this paper we illustrate possible mechanisms both with Optical coherence tomography (OCT) and histology. Design: We present two cases with ACS from very late stent thrombosis, both previously treated with first generation drug eluting stents (DES). Results: The first patient had ACS 15 months after DES implantation. The angiogram (CAG) was near normal with slight peri-stent contrast staining. OCT revealed abnormalities including thrombus not ...

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    17. Calibration of intravascular optical coherence tomography as presented in peer reviewed publications

      Calibration of intravascular optical coherence tomography as presented in peer reviewed publications

      Intravascular optical coherence tomography (OCT) is a new imaging modality in interventional cardiology providing high-resolution intracoronary images. The modality is already established as an efficient and precise research tool and is increasingly used for guiding coronary intervention. The quantitative capabilities of marketed OCT systems have been validated and measurements are found accurate and precise in bench testing .

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    18. Randomized study to assess the effect of thrombus aspiration on flow area in patients with ST-elevation myocardial infarction: an optical frequency domain imaging study—TROFI trial

      Randomized study to assess the effect of thrombus aspiration on flow area in patients with ST-elevation myocardial infarction: an optical frequency domain imaging study—TROFI trial

      Aims Primary percutaneous coronary intervention (PPCI) with thrombectomy (TB) seems to reduce the thrombus burden, resulting in a larger flow area as measured with optical frequency domain imaging (OFDI). Methods and results In a multi-centre study, 141 patients with ST elevation myocardial infarction <12 h from onset were randomized to either PPCI with TB using an Eliminate catheter (TB: n = 71) or without TB (non-TB: n = 70), having operators blinded for the OFDI results. The primary endpoint was minimum flow area (MinFA) post-procedure assessed by OFDI, defined as: [stent area + incomplete stent apposition (ISA) area] − (intraluminal defect + tissue prolapse area ...

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    1-18 of 18
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    Randomized study to assess the effect of thrombus aspiration on flow area in patients with ST-elevation myocardial infarction: an optical frequency domain imaging study—TROFI trial Calibration of intravascular optical coherence tomography as presented in peer reviewed publications Clinical use of Optical Coherence Tomography to identify angiographic silent stent thrombosis Serial optical frequency domain imaging in STEMI patients: the follow-up report of TROFI study Left Main Coronary Artery Lesions and Optical Coherence Tomography Co-registration of Optical Coherence Tomography and X-ray Angiography in Percutaneous Coronary Intervention. The Does Optical Coherence Tomography Optimize Revascularization (DOCTOR) Fusion Study OCT for bifurcation stenting: what have we learned? Uncertain Detection of Nonuniform Scaffold Expansion Patterns Using Optical Coherence Tomography Stent collapse after guide extension catheter collision. Signature procedural finding by optical coherence tomography Inducing Persistent Flow Disturbances Accelerates Atherogenesis and Promotes Thin Cap Fibroatheroma Development in D374Y-PCSK9 Hypercholesterolemic Minipigs Normative data and associations of Optical Coherence Tomography Angiography measurements of the macula: The Singapore Malay Eye Study Automatic Segmentation and Measurement of Choroid Layer in High Myopia for OCT Imaging Using Deep Learning