1. Articles from Javier Cuesta

    1-24 of 37 1 2 »
    1. The double injection technique to improve visualization of severe coronary lesions with optical coherence tomography

      The double injection technique to improve visualization of severe coronary lesions with optical coherence tomography

      Background: Optical coherence tomography (OCT) is a high-resolution imaging modality that provides a precise evaluation of coronary anatomy. However, the presence of severe coronary lesions can prevent the required adequate distal contrast flushing resultting in inadequate blood clearance and poor image quality or complete blood shadowing of the underlying vessel wall. Objectives: The aim of this prospective study was to evaluate the feasibility and safety of a novel "double injection technique" (DIT) to overcome the limitations of the conventional technique (CT) in patients with severely stenotic lesions. Methods: Twenty-three patients with severe angiographic lesions were sequentially imaged before intervention with ...

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    2. Treatment of in-stent restenosis with sirolimus-eluting magnesium bioresorbable scaffolds

      Treatment of in-stent restenosis with sirolimus-eluting magnesium bioresorbable scaffolds

      Objectives: To assess the value of sirolimus-eluting magnesium bioresorbable scaffolds (MgS) in the treatment of patients with in-stent restenosis (ISR). The better option for the treatment of patients with ISR remains unsettled. Bioresorbable vascular scaffolds represent an interesting strategy in this setting to avoid another permanent metal layer. The novel MgS is an attractive option to treat these challenging patients. Methods: We present the results of the first prospective series of consecutive patients with ISR treated with MgS under optical coherence tomography (OCT) guidance. Results: A total of 14 patients (15 lesions) were prospectively included. The mean age was 67 ...

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    3. Optical coherence tomography tissue coverage and characterization at six months after implantation of bioresorbable scaffolds versus conventional everolimus eluting stents in the ISAR-Absorb MI trial

      Optical coherence tomography tissue coverage and characterization at six months after implantation of bioresorbable scaffolds versus conventional everolimus eluting stents in the ISAR-Absorb MI trial

      Purpose: Data regarding vessel healing by optical coherence tomography (OCT) after everolimus-eluting bioresorbable scaffolds (BRS) or everolimus-eluting metallic stent (EES) implantation in acute myocardial infarction (AMI) patients is scarce. We compared OCT findings after BRS or EES implantation in patients with AMI enrolled in a randomized trial. Methods: In ISAR-Absorb MI, AMI patients were randomized to BRS or EES implantation, with 6-8 month angiographic follow-up. This analysis includes patients who underwent OCT during surveillance angiography. Tissue characterization was done using grey-scale signal intensity analysis. The association between OCT findings and target lesion failure (TLF) at 2 years was investigated. Results ...

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    4. 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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    5. 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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    6. 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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    7. 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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    8. Early restenosis of resorbable magnesium scaffolds: Optical coherence tomography findings

      Early restenosis of resorbable magnesium scaffolds: Optical coherence tomography findings

      Resorbable Magnesium Scaffolds (RMS) represent an interesting alternative to current drug‐eluting stents. Current data from clinical trials seems to confirm good performance of these new devices with low rates of late device failure. Little is known about mechanisms leading to RMS failure. Herein, we present the first description of an early RMS in‐scaffold restenosis. Optical coherence tomography (OCT) analysis at implantation detected acute non‐severe malapposition and underexpansion as main promoters of RMS failure. OCT during in‐scaffold restenosis intervention confirmed early severe neointimal proliferation and RMS late recoil and dismantling as the main mechanisms of device failure ...

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    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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    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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    11. 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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    12. 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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    13. Optical Coherence Tomography Findings in Patients with Coronary Stent Thrombosis: A Report of the PREvention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Consortium

      Optical Coherence Tomography Findings in Patients with Coronary Stent Thrombosis: A Report of the PREvention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Consortium

      Background —Stent thrombosis (ST) is a serious complication following coronary stenting. Intravascular optical coherence tomography (OCT) may provide insights into mechanistic processes leading to ST. We performed a prospective, multicenter study to evaluate OCT findings in patients with ST. Methods —Consecutive patients presenting with ST were prospectively enrolled in a registry using a centralized telephone registration system. After angiographic confirmation of ST, OCT imaging of the culprit vessel was performed with frequency domain OCT. Clinical data were collected according to a standardized protocol. OCT acquisitions were analyzed at a core laboratory. Dominant and contributing findings were adjudicated by an imaging ...

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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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    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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    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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    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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    1-24 of 37 1 2 »
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