1. Articles from Allen Jeremias

    1-20 of 20
    1. Visualizing Inside Conduits – Intraoperative Screening of Grafts by Optical Coherence Tomography

      Visualizing Inside Conduits – Intraoperative Screening of Grafts by Optical Coherence Tomography

      PURPOSE Saphenous vein graft (SVG) failure is a complex phenomenon, with technical, biological and local factors contributing to early-, medium- and long-term failure after coronary artery bypass graft (CABG). Both technical and conduit factors may have significant impact on the early SVG failure. DESCRIPTION We review the complex factors that play a pathogenic role in SVG failure followed by reviewing the existing literature on potential utility of high-definition optical coherence tomography (OCT) in comprehensive intraoperative assessment of SVGs. EVALUATION We describe a new technique for intraoperative acquisition of OCT images in the harvested SVGs, and introduce a classification system for ...

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    2. 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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    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.

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    5. Comparison of quantitative calcium parameters between optical coherence tomography and invasive coronary angiography

      Comparison of quantitative calcium parameters between optical coherence tomography and invasive coronary angiography

      Introduction and objectives: Former studies have associated the severity of calcified plaques (CP) on the invasive coronary angiography (ICA) with a limited number of optical coherence tomography (OCT) measurements. The objective of this study was to describe the correlation between an extended and comprehensive set of OCT measurements and the severity of calcifications as seen on the ICA. Methods: We retrospectively studied 75 patients (75 lesions) who underwent ICA and, concurrently, OCT imaging at a single institution. The OCT was performed before the percutaneous coronary intervention and after the administration of intracoronary nitroglycerine. The coronary artery calcium was scored using ...

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    6. 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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    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. 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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    9. 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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    10. Left coronary artery calcification patterns after coronary bypass graft surgery: An in‐vivo optical coherence tomography study

      Left coronary artery calcification patterns after coronary bypass graft surgery: An in‐vivo optical coherence tomography study

      Objectives We sought to evaluate the severity and patterns of calcifications in the left main coronary artery (LMCA) and proximal segments of left anterior descending coronary artery (LAD) and left circumflex artery (LCX) using optical coherence tomography (OCT) in patients with and without prior coronary artery bypass grafting (CABG). Background CABG may accelerate upstream calcium development. Methods OCT images ( n = 76) of the LMCA bifurcation from either the LAD or LCX in 76 patients with at least one patent left coronary graft, on average 7.0 ± 5.6 years post‐CABG, were compared with 148 OCT images in propensity‐score ...

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    11. 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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    12. 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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    13. 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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    14. Precision percutaneous coronary intervention: Is optical coherence tomography co‐registration the future?

      Precision percutaneous coronary intervention: Is optical coherence tomography co‐registration the future?

      Integration of angiographic co‐registration (ACR) with optical coherence tomography (OCT) leads to significant changes in PCI strategy. ACR with OCT allows complete integration of all available data‐points to aid decision making. Randomized clinical trials comprehensively evaluating the impact of OCT with ACR to improve clinical outcomes are ongoing.

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    15. The Effectiveness of Excimer Laser Angioplasty to Treat Coronary In-Stent Restenosis With Peri-stent Calcium as Assessed by Optical Coherence Tomography

      The Effectiveness of Excimer Laser Angioplasty to Treat Coronary In-Stent Restenosis With Peri-stent Calcium as Assessed by Optical Coherence Tomography

      Aims: We evaluated the effectiveness of excimer laser coronary angioplasty (ELCA) to treat in-stent restenosis (ISR) due to peri-stent calcium-related stent under-expansion as assessed by optical coherence tomography (OCT). Methods and results: We studied 81 patients (81 lesions with ISR, stent under-expansion, and peri-stent calcium >90°) who underwent OCT imaging both pre- and post-percutaneous coronary intervention and compared lesions treated with ELCA (n=23) vs without ELCA (n=58). ELCA use was associated with more calcium fracture (ELCA: 61%, non-ELCA: 12%, p<0.01), . larger final minimum lumen area (ELCA: 4.76 mm2 [3.25, 5.57], non-ELCA: 3.46 ...

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    16. 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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    17. 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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    1-20 of 20
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    1. (8 articles) Cardiovascular Research Foundation
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    Expert consensus statement on the use of fractional flow reserve, intravascular ultrasound, and optical coherence tomography a consensus statement of the society of cardiovascular angiography and interventions Utility of intracoronary imaging in the cardiac catheterization laboratory: comprehensive evaluation with intravascular ultrasound and optical coherence tomography Bifurcation and Ostial Optical Coherence Tomography Mapping (BOOM) – Case Description of a Novel Bifurcation Stent Technique The Effectiveness of Excimer Laser Angioplasty to Treat Coronary In-Stent Restenosis With Peri-stent Calcium as Assessed by Optical Coherence Tomography Precision percutaneous coronary intervention: Is optical coherence tomography co‐registration the future? Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography In-Stent Restenosis Lesion Morphology Related to Repeat Stenting Underexpansion as Evaluated by Optical Coherence Tomography Competency-Based Assessment of Interventional Cardiology Fellows’ Abilities in Intracoronary Physiology and Imaging Prospective Comparison Between Saline and Radiocontrast for Intracoronary Imaging With Optical Coherence Tomography Optical Coherence Tomography in Acute Coronary Syndromes The truth about invisible posterior vitreous structures Increased Macrophage-like Cell Density in Retinal Vein Occlusion as Characterized by en Face Optical Coherence Tomography