1. Articles in category: Cardiology

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    1. Intricacies in the analysis and interpretation of optical coherence tomography findings

      Intricacies in the analysis and interpretation of optical coherence tomography findings

      The assessment of arterial wall healing following DES implantation with the use of optical coherence tomography (OCT) has become a standard in the systematic evaluation of coronary stents. As a result, the number of scientific manuscripts on stents and OCT has proliferated, and stent characteristics including strut coverage and malapposition are reported based on their association with stent thrombosis in observational studies1. In this issue of EuroIntervention, Kim and colleagues2 present the results of a randomised comparison between new-generation biodegradable biolimus-eluting stents… 

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    2. Impact of strut-vessel distance and underlying plaque type on the resolution of acute strut malapposition: serial optimal coherence tomography analysis after everolimus-eluting stent implantation

      Impact of strut-vessel distance and underlying plaque type on the resolution of acute strut malapposition: serial optimal coherence tomography analysis after everolimus-eluting stent implantation

      The consequences of acute strut malapposition in everolimus-eluting stents (EES) are unknown. This study investigated the impact of strut–vessel (S–V) distance and plaque type underneath acute strut malapposition on the mid-term vessel response in EES. Twenty-nine patients (35 EES) underwent optical coherence tomography (OCT) immediately after percutaneous coronary intervention and at 8-month follow-up. S–V distance and plaque type (lipid, calcified, or fibrous) underneath acute strut malapposition were evaluated. Follow-up OCT classified acute strut malapposition as persistent or resolved. The S–V cutoff value for predicting resolved strut malapposition and the incidence of intra-stent thrombi were determined. Among ...

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    3. Advances in the Understanding of Plaque Composition and Treatment Options - Year in Review

      Advances in the Understanding of Plaque Composition and Treatment Options - Year in Review

      Atherosclerosis research has classically followed 2 intertwining lines of investigation concerning atherosclerosis as a local process (the “high-risk plaque”) and as a systemic disease (the “high-risk patient”). Over time, the weight of attention has swung, like a pendulum, between these 2 related foci. With optimal medical therapy and attention to risk factors firmly established as fundamental aspects of management, in the past year, we have nevertheless perceived a shift in the pendulum toward renewed focus on the local plaque. We contend that this shift results from a convergence of major advances in understanding the biology of plaque progression, novel sophisticated ...

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    4. The impact of lumen size and microvascular resistance on Fourier-domain optical coherence tomography (FD-OCT) coronary measurements

      The impact of lumen size and microvascular resistance on Fourier-domain optical coherence tomography (FD-OCT) coronary measurements

      Fourier-domain optical coherence tomography (FD-OCT) is a catheter based intravascular imaging modality providing high-resolution images of the coronary lumen. During image acquisition, angiographic contrast media is injected via an infusion pump to achieve effective intracoronary clearance of blood for optimal image acquisition. The influence of shear stress on FD-OCT images and subsequent measurement analysis has a potential to vary at differing macro- and microvascular conditions .

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    5. Expectations and limitations of contemporary intravascular imaging: lessons learned from pathology

      Expectations and limitations of contemporary intravascular imaging: lessons learned from pathology

      Acute coronary syndrome is the leading cause of death worldwide and plaque rupture is the most common underlying mechanism of coronary thrombosis. During the last 2 decades the understanding of atherosclerotic plaque progression advanced dramatically and pathology studies provided fundamental insights of underlying plaque morphology, which paved the way for invasive imaging modalities, which bring a new area of atherosclerotic plaque characterization in vivo. The development of intravascular ultrasound (IVUS) allowed the field to evaluate the principles of vascular anatomy, which is often underestimated by coronary angiography. Furthermore, IVUS image technologies were developed to obtain improved characterization of plaque composition ...

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    6. Optical Coherence Tomography-guided Bifurcation Stenting of a Coronary Artery Dissection

      Optical Coherence Tomography-guided Bifurcation Stenting of a Coronary Artery Dissection

      Periprocedural guide-wire induced coronary artery dissection is a rare but potentially serious complication of PCI. Immediate stenting of the entry point is one of the therapeutic options but engaging the guide-wire in the true lumen may be challenging. We report a case of a 55-year-old woman with a guide-wire induced coronary dissection that occurred during treatment of a bifurcation lesion. Optical coherence tomography was instrumental to distinguish true form false lumen and thereby guide correct positioning of the guide-wire to successfully treat the lesion using a dedicated bifurcation stent.

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    7. Serial optical coherence tomography assessments at 2- and 4-month follow-up after paclitaxel-eluting stenting of the superficial femoral artery

      Serial optical coherence tomography assessments at 2- and 4-month follow-up after paclitaxel-eluting stenting of the superficial femoral artery

      A 71-year-old man underwent endovascular therapy (EVT) with a paclitaxel-eluting stent in superficial femoral artery (SFA). Optical coherence tomography (OCT) of SFA at 2 months after EVT revealed that several struts were not covered with neointima. Moreover, some mural thrombi were detected within the stent. Although OCT revealed that the frequency of stent strut coverage was improved at the 4-month follow-up, uncovered stent strut still remained and some mural thrombi were observed within the stent even at 4 months after EVT. This is the first report to demonstrate the vascular response after paclitaxel-eluting stent placement for the lesion using serial ...

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    8. MGH Receives NIH Grant for Development of a Preclinical Optical Frequency Domain Angiography Instrument

      MGH Receives NIH Grant for Development of a Preclinical Optical Frequency Domain Angiography Instrument

      Massachusetts General Hospital Receives a 2014 NIH Grant for $467,429 for Development of a Preclinical Optical Frequency Domain Angiography Instrument. The principal investigator is Benjamin Vakoc. The program began in 2012 and ends in 2017. Below is a summary of the proposed work. Tumor-induced angiogenesis plays a central role in the progression of tumors to malignancy, provides the critical transport of blood-born therapies into the tumor space, and supplies oxygen to effectuate oxygen-dependent radiological and light-based therapies. Pre-clinical research in tumor angiogenesis and tumor microvascular function has traditionally relied on histological methods, which suffer from well-known limitations, or fluorescence-based ...

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    9. Optical Coherence Tomographic Evaluation of Transplant Coronary Artery Vasculopathy With Correlation to Cellular Rejection

      Optical Coherence Tomographic Evaluation of Transplant Coronary Artery Vasculopathy With Correlation to Cellular Rejection

      Background— Cardiac allograft vasculopathy is an accelerated fibroproliferative process that affects the coronary arteries of transplant ed hearts. Intra coronary imaging with optical coherence to mography enables detection of subangiographic cardiac allograft vasculopathy . Methods and Results— At the time of routine surveillance coronary angiography, 48 consecutive heart transplant recipients underwent optical coherence tomographic imaging of 1 coronary artery . Imaging findings were compared per rejection his to ry that was graded according to the International Society of Heart and Lung Transplant ation classification as none/mild (International Society of Heart and Lung Transplant ation 0, 1A/1B, or 2) or high-grade ...

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    10. St. Jude Medical Recognized as Innovative Technology Supplier of the Year by Nation’s Largest Health Care Contracting Organization

      St. Jude Medical Recognized as Innovative Technology Supplier of the Year by Nation’s Largest Health Care Contracting Organization

      St. Jude Medical, Inc . ( STJ ), a global medical device company, was recognized by Novation as the 2013 Innovative Technology Supplier of the Year. Novation members selected the St Jude Medical ILUMIEN™ PCI Optimization System based on their experience using the technology to deliver improved patient outcomes. Novation works with its more than 100,000 members and affiliates to identify innovative technology that improves patient care or reduces the risk of harm to patients or providers, while simultaneously raising the standard of patient care and safety. “Novation’s goals of improving patient outcomes through innovative technology align with our mission at ...

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    11. Optical coherence tomography imaging of everolimus-eluting bioresorbable vascular scaffold implanted into coronary vein graft at 3-month follow-up

      Optical coherence tomography imaging of everolimus-eluting bioresorbable vascular scaffold implanted into coronary vein graft at 3-month follow-up

      A 54-year-old male with stable angina, hypertension, and dyslipidaemia, as well as a history of coronary artery bypass grafting with implantation of two saphenous vein grafts to left anterior descending artery (LAD) (Ao-LAD) and diagonal branch (Ao-D1) 23 years ago. Coronary angiography done because of recurrent angina revealed a chronic total occlusion of the right coronary artery, occlusion of Ao-LAD, and significant stenosis of Ao-D1. Quantitative coronary angiography (QCA) showed...

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    12. New Insights on Plaque Erosion and Calcified Nodules “Seeing Is Believing”

      New Insights on Plaque Erosion and Calcified Nodules “Seeing Is Believing”

      Plaque erosion (PE) and calcified nodules (CN) have been classically described in pathological studies as causes of acute coronary syndromes (ACS) ( 1 ). However, until very recently, the diagnosis of these entities in the clinical setting has remained largely elusive ( 1 ). In this regard, the study of Jia et al. 2 , using optical coherence tomography (OCT) for the diagnosis of PE and CN, is of major clinical interest and raises several important issues. First, the investigators considered that OCT might provide a “definitive” diagnosis of PE when fibrous cap disruption is excluded and a thrombus overlying an “intact” plaque is visualized ...

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    13. Mechanisms, Pathophysiology, and Clinical Aspects of Incomplete Stent Apposition

      Mechanisms, Pathophysiology, and Clinical Aspects of Incomplete Stent Apposition

      Incomplete stent apposition (ISA) is characterized by the lack of contact of at least 1 stent strut with the vessel wall in a segment not overlying a side branch; it is more commonly found in drug-eluting stents than bare-metal stents. The accurate diagnosis of ISA, initially only possible with intravascular ultrasound, can currently be performed with higher accuracy by optical coherence tomography, which also enables strut-level assessment due to its higher axial resolution. Different circumstances related both to the index procedure and to vascular healing might influence ISA occurrence. Although several histopathology and clinical studies linked ISA to stent thrombosis ...

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    14. Spatial Heterogeneity of Neoatherosclerosis, and its Relationship with Neovascularization and Adjacent Plaque Characteristics: Optical Coherence Tomography Study

      Spatial Heterogeneity of Neoatherosclerosis, and its Relationship with Neovascularization and Adjacent Plaque Characteristics: Optical Coherence Tomography Study

      Background Development of neoatherosclerosis (NA) has been reported to be a potential cause of late stent failure. However, the distribution of NA and its relationship with neovascularization (NV) and adjacent plaque characteristics remain unclear. Methods We investigated 167 stents (40 bare-metal stents, 84 sirolimus-eluting stents, and 43 everolimus-eluting stents) with optical coherence tomography. Each stent was divided into the proximal section (PS), mid section (MS) and distal section (DS). NA was defined as lipid-laden neointima or calcification inside stent. Adjacent plaque characteristics were evaluated within 5 mm proximal and distal reference segments. Results NA was more frequent in PS and ...

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    15. Combined In Vivo Insights Unraveling the Underlying Substrate of an Acute Myocardial Infarction Treated With a Bioabsorbable Vascular Scaffold

      Combined In Vivo Insights Unraveling the Underlying Substrate of an Acute Myocardial Infarction Treated With a Bioabsorbable Vascular Scaffold

      An 86-year-old man presented with an ST-segment elevation inferior myocardial infarction. Coronary angiography revealed a large filling defect in the proximal right coronary artery (Figure 1 A) that was significantly reduced after thromboaspiration (Figure 1 B). On visual examination, the aspirated material appeared to be just a large red thrombus (Figure 1 D and Figure 1 E). Optical coherence tomography (OCT) disclosed the culprit lesion, which consisted of a red thrombus and a ruptured thin-cap fibroatheroma (Figure 2 A and Figure 2 A′). After thrombectomy, a large lumen was obtained, but a thin-cap fibroatheroma with some calcified areas and residual ...

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    16. A new method for real-time co-registration of 3-D coronary angiography and intravascular ultrasound or optical coherence tomography

      A new method for real-time co-registration of 3-D coronary angiography and intravascular ultrasound or optical coherence tomography

      We present a new clinically practical setup for online co-registration of 3D quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) or optical coherence tomography (OCT). The workflow is based on two modified commercially available software packages. Reconstruction steps are explained and compared to previously available methods. The feasibility for different clinical scenario is illustrated. The co-registration appears accurate, robust and induced a minimal delay on the normal cathlab activities. This new method is based on the 3D reconstruction of the catheter path and does not require operator’s judgment to establish the image synchronization based on visible landmarks.

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    17. 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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    18. Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention

      Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention

      Aims: The Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) represents an important advance in percutaneous coronary intervention (PCI) technology. With increasing use of BVS, it is important to understand its expansion characteristics to ensure optimal scaffold deployment. Optical coherence tomography (OCT) has been shown to improve detection of intraprocedural complications compared with conventional intravascular imaging modalities. This study aimed to determine whether or not OCT, post successful angiographic BVS implantation, influenced decision making with regard to the need for further scaffold optimisation. Methods and results: Consecutive patients undergoing OCT-guided BVS implantation from August 2012 to March 2013 were reviewed to determine ...

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    19. Techniques and best practices for optical coherence tomography: A practical manual for interventional cardiologists

      Techniques and best practices for optical coherence tomography: A practical manual for interventional cardiologists

      Optical Coherence Tomography (OCT) is a novel intracoronary imaging modality that utilizes near-infrared light to provide information regarding lesion length and severity, vessel lumen diameter, plaque morphology, as well as the opportunity for stent procedure guidance and follow-up. While analogous to intravascular ultrasound (IVUS), the specific imaging properties, including significantly higher resolution, and technical specifications of OCT offer the ability for intracoronary diagnostic and interventional procedure guidance roles that require a thorough understanding of the technology. We provide coronary interventionalist's a user's guide to OCT, focusing on techniques and approaches to optimize imaging, with a focus on efficiency ...

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