1. Articles from Fernando Rivero

    1-24 of 37 1 2 »
    1. Diagnosis of Intraplaque Hemorrhage by High-Definition Intravascular Ultrasound and Optical Coherence Tomography

      Diagnosis of Intraplaque Hemorrhage by High-Definition Intravascular Ultrasound and Optical Coherence Tomography

      A 67-year-old woman, a heavy smoker and with hypothyroidism, presented with a non–STsegment elevation myocardial infarction with negative T waves on the inferior leads. Coronary angiography revealed a focal stenosis in the mid right coronary artery (arrow in Figure 1A) but no other coronary lesions. High-definition (60-MHz) intravascular ultrasound (IVUS) (ACIST Medical Systems, Eden Prairie, Minnesota) revealed a large hyperechoic noncalcific plaque encompassing a well-delineated, crescent-shaped area showing a striking hypoechogenicity (echolucent “black” area) (yellow asterisks in Figures 1B and 1C [white asterisk denotes wire artifact]). The immediately adjacent plaque had a more reflective pattern with marked speckling (Figures ...

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    2. Severe coronary spasm in a COVID‐19 patient

      Severe coronary spasm in a COVID‐19 patient

      Myocardial injury is frequently detected in coronavirus disease 2019 (COVID‐19) patients. However, up to one‐third of COVID‐19 patients showing ST‐segment elevation on the electrocardiogram have angiographically normal coronary arteries. We present a case of an acute coronary syndrome due to a coronary spasm in a severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) patient. This pathophysiological mechanism was clearly demonstrated by intracoronary imaging techniques (optical coherence tomography) and invasive vasospasm test.

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      Mentions: Fernando Alfonso
    3. Very late stent thrombosis of a titanium-nitride-oxide-coated bioactive stent resulting from neoatherosclerosis: Optical coherence tomography insights

      Very late stent thrombosis of a titanium-nitride-oxide-coated bioactive stent resulting from neoatherosclerosis: Optical coherence tomography insights

      This is the first reported case of a BAS very late stent thrombosis resulting from ruptured neoatherosclerosis. • Optical Coherence Tomography provides unique insight to unravel the presence of neoatherosclerosis. • Very late stent thrombosis of BAS resulting from neoatherosclerosis is an uncommon but feared complication.

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    4. Characteristic findings of acute spontaneous coronary artery dissection by cardiac computed tomography

      Characteristic findings of acute spontaneous coronary artery dissection by cardiac computed tomography

      Background: Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS); however, its detection carries relevant clinical implications. Cardiac computed tomography (CCT) has been found to be useful for follow-up, but data during the acute phase are scarce. Thus, our aim was to evaluate the early diagnostic ability of CCT to detect SCAD. Methods: We retrospectively analyzed all the in-hospital CCT performed in a prospective cohort of patients with SCAD from 2012 to 2016. An independent expert blindly evaluated the studies and described the radiologic characteristics of the lesions. These features were compared with the invasive ...

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    5. Plasmonic Copper Sulfide Nanoparticles Enable Dark Contrast in Optical Coherence Tomography

      Plasmonic Copper Sulfide Nanoparticles Enable Dark Contrast in Optical Coherence Tomography

      Optical coherence tomography (OCT) is an imaging technique affording noninvasive optical biopsies. Like for other imaging techniques, the use of dedicated contrast agents helps better discerning biological features of interest during the clinical practice. Although bright OCT contrast agents have been developed, no dark counterpart has been proposed yet. Herein, plasmonic copper sulfide nanoparticles as the first OCT dark contrast agents working in the second optical transparency window are reported. These nanoparticles virtually possess no light scattering capabilities at the OCT working wavelength (≈1300 nm); thus, they exclusively absorb the probing light, which in turn results in dark contrast. The ...

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      Mentions: Fernando Alfonso
    6. Role of optical coherence tomography for distal left main stem angioplasty

      Role of optical coherence tomography for distal left main stem angioplasty

      Objective The objective is to analyze the acute and midterm angiographic outcome of percutaneous treatment of left main coronary stem (LM‐PCI) guided by optical coherence tomography (OCT). Background LM‐PCI is a complex procedure, and several anatomical factors may impair its outcome. Intravascular imaging is emerging as a useful tool to guide the procedure. Methods We conducted a retrospective analysis of patients undergoing LM‐PCI at three European centers between 2014 and 2017 with a control angiography at 6–12 months. Patients were divided into two groups: OCT‐guidance (pre‐ and post‐PCI) and control group (standard angiographic guidance ...

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    7. Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis

      Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis

      Aims To describe optical coherence tomography (OCT) findings in patients with in-stent restenosis (ISR) and determine predictors of neointimal patterns and neoatherosclerosis. Methods and results Patients undergoing OCT prior to PCI for ISR in three European centres were included. Analyses were performed in a core laboratory. Qualitative and quantitative [gray-scale signal intensity (GSI)] neointima analyses were performed on a per quadrant basis. A total of 107 patients were included. Predominantly homogeneous lesions included 4.5% (0.0–14.3) non-homogeneous quadrants, while predominantly non-homogeneous ones included 28.1% (20.3–37.5) homogeneous quadrants. Mean GSI values differed significantly between ...

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    8. Calcified neoatherosclerosis causing in-stent restenosis: prevalence, predictors, and implications

      Calcified neoatherosclerosis causing in-stent restenosis: prevalence, predictors, and implications

      Background Neoatherosclerosis has emerged as a major cause of in-stent restenosis (ISR). Although this entity has been described as a unique process, optical coherence tomography (OCT) enables depiction of distinct morphologic patterns, including the presence of calcified sheets within the stent. We sought to assess prevalence, predictors, and implications of calcified neoatherosclerosis (cNA) as the cause of ISR. Methods and results From January 2014 to August 2016, 75 consecutive patients with 81 ISR lesions with a clinical indication for revascularization were evaluated by OCT before reintervention. In 13 (16%) lesions, cNA was the predominant pattern of ISR, all of them ...

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      Mentions: Fernando Alfonso
    9. Delayed Appearance of Intramural Hematoma After Stent Implantation: Diagnosis by Optical Coherence Tomography

      Delayed Appearance of Intramural Hematoma After Stent Implantation: Diagnosis by Optical Coherence Tomography

      A 55-year-old man presented with an inferior myocardial infarction successfully treated with fibrinolysis. Elective coronary angiography revealed a tight lesion at the most proximal segment of the right coronary artery ( Video1 ). Following lesion predilation a drug-eluting stent (DES) was implanted and subsequently optimized using optical coherence tomography (OCT) guidance (Video 2). OCT confirmed an excellent final result. In particular, the distal edge of the stent was nicely expanded and apposed against the vessel wall and no edge-dissections were detected ( Figure 1A-D, Video 3 )

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      Mentions: Fernando Alfonso
    10. Bioresorbable vascular scaffold restenosis treated with sirolimus-eluting balloon: Optical coherence tomography findings

      Bioresorbable vascular scaffold restenosis treated with sirolimus-eluting balloon: Optical coherence tomography findings

      A 60-year-old man was admitted for unstable angina. Two-years ago he was treated with two bioresorbable vascular scaffolds (BVSs) on the proximal and distal segments of the left anterior descending coronary artery ( Figure 1 A, white arrows). Coronary angiography showed critical in-scaffold restenosis of the proximal BVS ( Figure 1 B, yellow arrow). Optical coherence tomography revealed heterogeneous tissue filling the BVS ( Figure 2 , A, B and D) with areas depicting bright neointimal hyperplasia with dorsal attenuation and marked shadowing of the underlying BVS struts. There was no evidence of scaffold disruption and neoatherosclerosis was considered the cause of late BVS ...

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      Mentions: Fernando Alfonso
    11. Gold nanoshells: Contrast agents for cell imaging by cardiovascular optical coherence tomography

      Gold nanoshells: Contrast agents for cell imaging by cardiovascular optical coherence tomography

      Optical coherence tomography (OCT) has gained considerable attention in interventional cardiovascular medicine and is currently used in clinical settings to assess atherosclerotic lesions and to optimize stent placement. Artery imaging at the cellular level constitutes the first step towards cardiovascular molecular imaging, which represents a major advance in the development of personalized noninvasive therapies. In this work, we demonstrate that cardiovascular OCT can be used to detect individual cells suspended in biocompatible fluids. Importantly, the combination of this catheter-based clinical technique with gold nanoshells (GNSs) as intracellular contrast agents led to a substantial enhancement in the backscattered signal produced by ...

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      Mentions: Fernando Alfonso
    12. Very late scaffold thrombosis: insights from optical coherence tomography and histopathology

      Very late scaffold thrombosis: insights from optical coherence tomography and histopathology

      A 79-year-old male patient had a 2.5×12 mm bioresorbable vascular scaffold (Absorb™ BVS; Abbott Vascular, Santa Clara, CA, USA) implanted in the setting of the RIBS VI study protocol for in-stent restenosis of a 3×9 mm bare metal stent (AVE S670; Medtronic, Minneapolis, MN, USA) in January 2015, at which time point the patient presented with stable angina and positive exercise stress test (index procedure). The Absorb BVS was implanted with predilatation at 20 atmospheres (atm) accompanied by post-dilatation with a non-compliant balloon (2.5×10 mm) at 26 atm. The patient was maintained on dual antiplatelet ...

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    13. Very Late Scaffold Thrombosis: Insights from Optical Coherence Tomography and Histopathology

      Very Late Scaffold Thrombosis: Insights from Optical Coherence Tomography and Histopathology

      Aims: to investigate and understand the mechanisms of very late scaffold thrombosis 13 months following implantation in the setting of bare metal in-stent restenosis. Methods and results: we collected consecutive angiography, optical coherence tomography and full autopsy evaluation in a 79-year old patients presenting with cardiogenic shock and undergoing rescue PCI after suffering very late scaffold thrombosis. Combined assessment of angiography, optical coherence tomography and histopathology revealed heterogenous vascular healing 13 months following implantation of a bioresorbable vascular scaffold with presence of scaffold struts fully integrated into neointimal tissue while others remained uncovered and malapposed. Furthermore, plaque rupture within the ...

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    14. Optical Coherence Tomography Findings in Patients With Recanalized Coronary Thrombi Treated With Bioresorbable Vascular Scaffolds

      Optical Coherence Tomography Findings in Patients With Recanalized Coronary Thrombi Treated With Bioresorbable Vascular Scaffolds

      Introduction Recanalized coronary thrombi (RCT) are rarely recognized in real-world clinical practice. Incidence and functional significance of RCT remain unclear. High-resolution imaging modalities, such as optical coherence tomography (OCT), may provide novel insight to further characterize this unique phenomenon. 1 , 2 We present a case series of RCT treated with bioresorbable vascular scaffold (BVS). Case 1 A 75-year-old man with a previous history of an inferior myocardial infarction was admitted with congestive heart failure. Inferior hypokinesia was detected on echocardiography. Coronary angiography showed a filling defect and luminal haziness in the proximal segment of the right coronary artery (Figure 1A ...

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    15. Coronary artery aneurysm formation following implantation of a bioresorbable vascular scaffold for in-stent restenosis

      Coronary artery aneurysm formation following implantation of a bioresorbable vascular scaffold for in-stent restenosis

      Coronary artery aneurysm (CAA) formation is a rare complication of coronary intervention that may develop after implantation of bare-metal or drug-eluting stents. The etiology of this entity appears to be multifactorial and its prognosis is poorly understood, but it has been associated with an increased risk of stent thrombosis. To date few cases of CAAs related to bioresorbable vascular scaffold (BVS) implantation have been reported, and the development of CAA after BVS implantation for the treatment of in-stent restenosis (ISR) has not been previously described. Here we present two cases of CAA formation after BVS, which represent the first demonstration ...

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      Mentions: Fernando Alfonso
    16. Iatrogenic Coronary Artery Dissection Induced During Invasive Absolute Coronary Blood Flow Measurement: Optical Coherence Tomography Findings

      Iatrogenic Coronary Artery Dissection Induced During Invasive Absolute Coronary Blood Flow Measurement: Optical Coherence Tomography Findings

      A 65-year-old woman with previous history of hypertension was referred to our institution due to effort angina with a positive exercise stress test. Coronary angiography showed normal coronary arteries. A vasospasm provocation test with methylergonovine was negative. With the aim of assessing the state of microvasculature, absolute coronary blood flow by thermodilution was performed as previously described.

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      Mentions: Fernando Alfonso
    17. Multifaceted Presentation of Recurrent Spontaneous Coronary Artery Dissection Angiography and Optical Coherence Tomography Findings

      Multifaceted Presentation of Recurrent Spontaneous Coronary Artery Dissection Angiography and Optical Coherence Tomography Findings

      A 58-year-old woman with a previous history of hypertension, hypercholesterolemia, and cigarette smoking presented with a non–ST-segment–elevation myocardial infarction with transient (nonpersistent) anterior ST-segment–elevation suggesting ischemia on the territory of the left anterior descending coronary artery. The coronary angiogram showed no signs of atherosclerosis but depicted severely tortuous coronary arteries with a focal lumen narrowing in the mid-segment of the left anterior descending coronary artery (Figure 1A). In addition, a diffuse lesion with a double lumen was demonstrated at the mid-segment of the posterior descending coronary artery branch of the right coronary artery (Figure 1B). Moreover, the ...

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      Mentions: Fernando Alfonso
    18. Multifaceted Presentation of Recurrent Spontaneous Coronary Artery Dissection Angiography and Optical Coherence Tomography Findings

      Multifaceted Presentation of Recurrent Spontaneous Coronary Artery Dissection Angiography and Optical Coherence Tomography Findings

      A 58-year-old woman with a previous history of hypertension, hypercholesterolemia, and cigarette smoking presented with a non–ST-segment–elevation myocardial infarction with transient (nonpersistent) anterior ST-segment–elevation suggesting ischemia on the territory of the left anterior descending coronary artery. The coronary angiogram showed no signs of atherosclerosis but depicted severely tortuous coronary arteries with a focal lumen narrowing in the mid-segment of the left anterior descending coronary artery (Figure 1A). In addition, a diffuse lesion with a double lumen was demonstrated at the mid-segment of the posterior descending coronary artery branch of the right coronary artery (Figure 1B). Moreover, the ...

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      Mentions: Fernando Alfonso
    1-24 of 37 1 2 »
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