1. Articles in category: Cardiology

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    1. Effect of Evolocumab on Coronary Plaque Characteristics

      Effect of Evolocumab on Coronary Plaque Characteristics

      The aim of the study is to assess the effect of evolocumab on coronary plaque morphology using intravascular imaging and gene expression analysis of peripheral blood mononuclear cells (PBMC) in patients with stable CAD on maximally tolerated statin therapy. The study combines multi-modality intravascular imaging approaches and transcriptomic based machine learning algorithms to uncover molecular mechanisms responsible for the beneficial changes in atherosclerotic lesions of patients treated with evolocumab. The primary end-points are the changes from baseline to follow-up in (1) the minimal fibrous cap thickness (FCT) assessed by optical coherence tomography (OCT) and (2) maxLCBI4mm assessed by near-infrared spectroscopy ...

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    2. The vessel density of the superficial retinal capillary plexus as a new biomarker in cerebral small vessel disease: an optical coherence tomography angiography study

      The vessel density of the superficial retinal capillary plexus as a new biomarker in cerebral small vessel disease: an optical coherence tomography angiography study

      Background: Optical coherence tomography angiography (OCTA) is a novel and noninvasive technique for the quantitative assessment of retinal microvascular perfusion. Since the retinal and cerebral small vessels share similar embryological origins, anatomical features, and physiological properties, altered retinal microvasculature might provide a new perspective on the mechanisms of cerebral small vessel disease (CSVD). Objective: We aimed to evaluate retinal vessel density (VD) in patients with CSVD using OCTA and identify associations with cerebral magnetic resonance imaging (MRI) markers and cognitive function. Methods: We prospectively recruited 47 CSVD patients and 30 healthy controls (HCs) to participate in the study. All participants ...

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    3. Trimethylamine N-Oxide Was Not Associated With 30-Day Left Ventricular Systolic Dysfunction in Patients With a First Anterior ST-Segment Elevation Myocardial Infarction After Primary Revascularization: A Sub-analysis From an Optical Coherence Tomography R

      Trimethylamine N-Oxide Was Not Associated With 30-Day Left Ventricular Systolic Dysfunction in Patients With a First Anterior ST-Segment Elevation Myocardial Infarction After Primary Revascularization: A Sub-analysis From an Optical Coherence Tomography R

      Objective: Left ventricular systolic dysfunction (LVSD) after ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. Trimethylamine N-oxide (TMAO), a gut metabolite, is linked to cardiovascular diseases but its relationship with LVSD after STEMI remains unclear. The present study therefore aimed to investigate the relationship between TMAO and LVSD at 30 days after a first anterior STEMI. Methods: This was a sub-study from the OCTAMI (Optical Coherence Tomography Examination in Acute Myocardial Infarction) registry. Eligible patients were included in current study if they: (1) presented with a first anterior STEMI; (2) had available baseline TMAO concentration; (3) completed a ...

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    4. Role of intravascular imaging for the diagnosis of recanalized coronary thrombus

      Role of intravascular imaging for the diagnosis of recanalized coronary thrombus

      Introduction Recanalized thrombus (RCT) of coronary arteries is frequently unrecognized in interventional cardiology practice. Intravascular imaging conclusively establishes its diagnosis, which otherwise is often misdiagnosed as fresh thrombus, spontaneous coronary artery dissection, or severe calcification based on angiography, alone. We hereby report our experience of 10 RCT patients, who had the intravascular imaging-guided diagnosis, followed by the successful percutaneous coronary intervention (PCI). Methods It was a retrospective analysis of 10 patients, who had angiographic haziness of the target lesion during PCI, which were found to be RCT on intravascular imaging. Either optical coherence tomography (OCT) or intravascular ultrasound (IVUS) was ...

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    5. Massachusetts General Hospital Receives NIH Grant for Unique Value of Real-Time Shear Stress to Enhance Coronary Disease Management

      Massachusetts General Hospital Receives NIH Grant for Unique Value of Real-Time Shear Stress to Enhance Coronary Disease Management

      Massachusetts General Hospital Receives a 2021 NIH Grant for $729,926 for Unique Value of Real-Time Shear Stress to Enhance Coronary Disease Management. The principal investigator is Guillermo Tearney. Below is a summary of the proposed work. Management of CAD is hindered by our inability to investigate fundamental pathobiologic processes that lead to individual coronary plaque progression, destabilization, and adverse clinical events. A critical mechanism responsible for plaque behavior is local endothelial shear stress (ESS), the frictional force of blood flowing across the endothelium, which is governed by the artery’s detailed local geometry. Focal regions of low ESS drive ...

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    6. Evaluation of Transthoracic Echocardiography in the Assessment of Atherosclerosis of the Left Main Coronary Artery: Comparison with Optical Frequency Domain Imaging (a Pilot Study)

      Evaluation of Transthoracic Echocardiography in the Assessment of Atherosclerosis of the Left Main Coronary Artery: Comparison with Optical Frequency Domain Imaging (a Pilot Study)

      Background: Risk stratification using non-invasive imaging of the coronary vessels is emerging as an optimal standard of care for patients with dyslipidemias. Of particular interest is the evaluation of the left main coronary artery (LMCA), where calcium deposition appears to be a predictor of cardiovascular events. Methods: In coronary patients, we evaluated wall thickness and internal diameter of the LMCA examined by transthoracic echocardiography (TTE) and compared these with findings obtained by optical frequency domain imaging (OFDI), this latter also used to evaluate calcium deposition. Results: A significant positive correlation between TTE and OFDI for the anterior wall thickness (r ...

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    7. Clinical significance of microvessels detected by in vivo optical coherence tomography within human atherosclerotic coronary arterial intima: a study with multimodality intravascular imagings

      Clinical significance of microvessels detected by in vivo optical coherence tomography within human atherosclerotic coronary arterial intima: a study with multimodality intravascular imagings

      The significance of microvessels within atherosclerotic plaques is not yet fully clarified. Associated with plaque vulnerability. The aim of this study is to examine tissue characteristics of plaque with microvessels detected by optical coherence tomography (OCT) by use of a commercially available color-coded intravascular ultrasound (IVUS) and coronary angioscopy (CAS). The subjects examined comprised of 44 patients with stable angina pectoris who underwent percutaneous coronary intervention. Microvessels were defined as a tiny tubule with a diameter of 50-300 µm detected over three or more frames in OCT. We compared the total volume of microvessels with tissue component such as fibrotic ...

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    8. Optical coherence tomography guidance: when one size does not fit all

      Optical coherence tomography guidance: when one size does not fit all

      This editorial refers to ‘External elastic lamina vs. luminal diameter measurement for determining stent diameter by optical coherence tomography: an ILUMIEN III substudy’ by E. Shlofmitz et al ., doi:10.1093/ehjci/jeaa276. The use of intravascular imaging is known to improve percutaneous coronary intervention (PCI) outcomes, especially in complex coronary anatomy and high-risk patients. While for intravascular ultrasound (IVUS) data from randomized clinical trials and meta-analysis are available, until now the evidence supporting optical coherence tomography (OCT) derives from large registries. 1 , 2 The journey of the ILUMIEN trial series has been pivotal for better understanding how to use ...

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    9. Shockwave Lithotripsy vs Rotational Atherectomy: Mechanistic Differences From Optical Coherence Tomography

      Shockwave Lithotripsy vs Rotational Atherectomy: Mechanistic Differences From Optical Coherence Tomography

      A 63-year-old man presented with a non-ST segment elevation myocardial infarction. He was referred to our hospital for percutaneous coronary intervention (PCI) with rotational atherectomy (RA) after an attempted PCI that was unsuccessful due to a severely calcified undilatable lesion (Figure 1A). The procedure was performed through the right radial approach with a 7.5 Fr sheathless AR2 guiding catheter. Multiple series for the lesion preparation and predilation were attempted, first using 1.5 mm and then 1.75 mm Rota burr (RotaLink Plus; Boston Scientific) followed by sequential non-compliant balloon dilations with several high-pressure, super-high-pressure, and scoring balloons. All ...

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    10. Plaque Erosion Prospective Study ii

      Plaque Erosion Prospective Study ii

      Plaque erosion is associated with myocardial infarction (MI) in about 30% of cases and may require a different management approach to plaque rupture. The investigators hypothesise that plaque erosion leads to higher levels of apoptotic circulating endothelial cells (CECs) compared to plaque rupture. Aims: To compare associations between plaque erosion and plaque rupture with numbers and types of apoptotic CECs in patients with non-ST elevation MI (NSTEMI) and stable coronary artery disease controls (CAD). Additional aims are to explore signals of cellular stress (mitochondrial dsDNA), sub-populations of activated neutrophils, circulating endothelial progenitor cells and erosion-specific plasma biomarkers. Methods: Prospective observational ...

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    11. Influence of Calcium Pattern on Plaque Modification Achieved With Intracoronary Lithotripsy

      Influence of Calcium Pattern on Plaque Modification Achieved With Intracoronary Lithotripsy

      Calcified coronary artery disease is a frequently encountered problem that can lead to poorer outcomes for patients undergoing PCI. Recently, intravascular lithotripsy has become available for the treatment of callcified coronary artery disease. The effect of intravascular lithotripsy on varying calcium patterns has not been adequately explored. This is an investigator initiated, open label, non-blinded, observational study involving a number of centers in Spain examining the effect of intravasuclar lithotripsy in varying calcium patterns. 100 patients wll be enrolled. Optical coherence tomography will be used to assess the effect of intravascular lithotripsy on varying calcium patterns (concentric, eccentric and nodular).

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    12. Diagnostic accuracy of optical coherence tomography for the identification of in-stent fibroatheroma following stent implantation: an ex vivo histological validation study

      Diagnostic accuracy of optical coherence tomography for the identification of in-stent fibroatheroma following stent implantation: an ex vivo histological validation study

      The accurate identification of in-stent fibroatheroma by in vivo imaging is clinically important to preventing the late catch-up phenomenon after stent deployment. This study investigated the diagnostic accuracy of optical coherence tomography (OCT) for the detection of "in-stent fibroatheroma" following stent implantation. Fifty stented coronary arteries from the 31 autopsy hearts were examined to compare OCT and histological image findings. A histological in-stent fibroatheroma was defined as a neointima containing an acellular necrotic core generated by macrophage infiltration. OCT-derived in-stent fibroatheroma comprised a heterogeneous pattern with an invisible stent strut behind the low-signal-intensity region. A total of 122 matched OCT ...

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      Mentions: Kenichi Fujii
    13. Optical coherence tomography and plaque morphology for revascularization of the superficial femoral artery

      Optical coherence tomography and plaque morphology for revascularization of the superficial femoral artery

      Background: The optical coherence tomography (OCT) catheter, Ocelot (Avinger Inc., Redwood City, CA), has been utilized to cross Trans-Atlantic Inter-Society Consensus Document (TASC) D lesions. Studies have assessed the characteristics of high-risk plaques in the carotid artery, but few, if any data exist evaluating OCT and plaque morphology in the superficial femoral artery (SFA). This study assessed SFA plaque morphology using OCT and lesion crossing success in chronic total occlusions (CTOs). Methods: We reviewed patients who underwent attempted infrainguinal revascularization with TASC D CTOs using the Ocelot catheter between June 2014 and June 2018, and recorded demographic information, smoking status ...

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    14. Close association of matrix metalloproteinase-9 levels with the presence of thin-cap fibroatheroma in acute coronary syndrome patients: Assessment by optical coherence tomography and intravascular ultrasonography

      Close association of matrix metalloproteinase-9 levels with the presence of thin-cap fibroatheroma in acute coronary syndrome patients: Assessment by optical coherence tomography and intravascular ultrasonography

      Background Thin-cap fibroatheroma (TCFA) has been suggested as a precursor lesion of coronary plaque rupture. As elevated plasma matrix metalloproteinase-9 (MMP-9) levels have been documented in patients with acute coronary syndrome (ACS), we sought to determine whether the presence of TCFA is linked to MMP-9 levels in these patients. Methods We evaluated 51 ACS patients with de novo culprit lesions who were examined via optical coherence tomography and intravascular ultrasound. Blood samples were obtained from the peripheral vein (PV) and the ostium and culprit lesion of the infarct-related coronary artery (CA) in the acute phase of ACS and from the ...

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    15. The Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent in Patients with Chronic Total Occlusion Evaluated by Clinical Outcome and Optical Coherence Tomography Imaging Analysis

      The Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent in Patients with Chronic Total Occlusion Evaluated by Clinical Outcome and Optical Coherence Tomography Imaging Analysis

      We sought to determine the effects of the use of a Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent (Combo ® DTS) in patients with chronic total occlusion (CTO) by evaluating clinical outcomes and by performing an optical coherence tomography (OCT) analysis. We retrospectively analyzed data from 39 patients who had successfully undergone OCT-guided revascularization of a CTO being treated with a Combo ® DTS. Clinical assessment, angiography (with quantitative coronary angiography analysis) and OCT examination were performed at baseline and at follow-up. The median follow-up period was 189 days, ranging from 157 to 615 days. At follow-up, revascularization was required due ...

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    16. Three-dimensional optical coherence tomography versus intravascular ultrasound in percutaneous coronary intervention for the left main coronary artery

      Three-dimensional optical coherence tomography versus intravascular ultrasound in percutaneous coronary intervention for the left main coronary artery

      We aimed to compare the intravascular imaging findings, and clinical outcomes between three-dimensional optical coherence tomography (OCT)- and intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for the left main coronary artery (LMCA). We enrolled 331 patients underwent OCT- or IVUS-guide single crossover stenting across the side branch (SB) and subsequent kissing balloon inflation (KBT) for LMCA bifurcation. Primary endpoint was defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization. Of 331 patients, 58 patients (17.5%) underwent OCT-guide PCI. OCT-guide PCI associated with higher frequency of proximal optimization technique (POT) (98.3% vs 85.3 ...

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    17. First in man evaluation of a sirolimus-eluting stent with abluminal fluoropolymeric/triflusal coating with ultrathin struts by OCT at 9 months follow up. The PROMETHEUS study

      First in man evaluation of a sirolimus-eluting stent with abluminal fluoropolymeric/triflusal coating with ultrathin struts by OCT at 9 months follow up. The PROMETHEUS study

      Objectives We sought to investigate stent healing and neointimal hyperplasia with ihtDEStiny drug-eluting stent (DES) by optical coherence tomography (OCT) examination conducted 9 months after implantation. Background The currently used DES present certain features that have been linked separately to their better performance in terms of efficacy and safety. Methods First-in-man, prospective and multicenter study including patients treated with ihtDEStiny stent undergoing OCT examination at 9 months follow up. The ihtDEStiny stent is a sirolimus eluting stent with an oval shape ultrathin struts (68 μm) and an abluminal coating of a fluoropolymer containing the antiplatelet agent triflusal. Primary endpoint was ...

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    18. Value of the optical coherence tomography in the diagnosis of unstable patients with non-significant coronary stenosis

      Value of the optical coherence tomography in the diagnosis of unstable patients with non-significant coronary stenosis

      Introduction and objectives: The final diagnosis of a myocardial infarction with non-obstructive coronary arteries (MINOCA) is often hard to achieve. Angiographic findings may be suggestive of the presence of unstable plaques although it is common to discharge patients without an etiologic diagnosis. The high spatial resolution provided by the optical coherence tomography (OCT) allows the detection of vulnerable and unstable coronary plaques that are prone to rupture, erosion, and thrombi which may lead to more targeted individual therapies. The objective of this study is to assess the utility of OCT when achieving an etiologic diagnosis in selected patients with MINOCA ...

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    19. Optical Coherence Tomography Images of an Occluded Pulmonary Vein After Atrial Fibrillation Ablation

      Optical Coherence Tomography Images of an Occluded Pulmonary Vein After Atrial Fibrillation Ablation

      A 44-year-old man who had undergone paroxysmal atrial fibrillation (AF) ablation 3 times at another hospital underwent endovascular treatment (EVT) for left superior pulmonary vein occlusion (LSPVO) due to hemoptysis following the administration of dabigatran (300 mg/day). At the initial EVT, dilatations using a 6-mm×20-mm balloon restored blood flow in the LSPV ( Figure A ). However, at the 3-month follow-up, enhanced computed tomography (CT) showed the recurrence of LSPVO, so secondary EVT was performed to prevent recurrent hemoptysis. Serial optical coherence tomography (OCT) images after dilatation with a 2-mm balloon ( Figure B–E ) revealed a hyperplastic neointima, mimicking a ...

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    20. Pre-Emptive OCT-Guided Angioplasty of Vulnerable Intermediate Coronary Lesions: Results from the Prematurely Halted PECTUS-Trial

      Pre-Emptive OCT-Guided Angioplasty of Vulnerable Intermediate Coronary Lesions: Results from the Prematurely Halted PECTUS-Trial

      Objectives: To assess the safety and efficacy of pre-emptive treatment of optical coherence tomography- (OCT-) derived vulnerable, non-flow-limiting, non-culprit lesions in patients with myocardial infarction (MI). Background: Intracoronary imaging with OCT can aid in the decision to treat non-flow-limiting lesions by identifying vulnerable plaques. Pre-emptive treatment of these lesions might improve patient outcome by "sealing" these plaques. Bioresorbable vascular scaffolds (BVS) have theoretical benefit for this treatment because they dissolve completely over time. Methods: In patients presenting with MI, non-culprit lesions with a fractional flow reserve ≥0.8 were imaged with OCT. Vulnerable plaques were randomised to either percutaneous coronary ...

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    21. Optical coherence tomography analysis of late lumen enlargement after paclitaxel‐coated balloon angioplasty for de‐novo coronary artery disease

      Optical coherence tomography analysis of late lumen enlargement after paclitaxel‐coated balloon angioplasty for de‐novo coronary artery disease

      Background Paclitaxel‐coated balloon angioplasty for de‐novo coronary artery lesions causes late lumen enlargement (LLE), however, the mechanisms and predictors of LLE have not been elucidated. Methods and Results We retrospectively analyzed 91 consecutive patients with 95 de‐novo coronary lesions, who underwent paclitaxel‐coated balloon angioplasty without stenting from August 2018 to July 2019 as well as follow‐up coronary angiography and optical coherence tomography (OCT). The mean follow‐up duration was 8.2 ± 2.9 months. The target lesion revascularization rate was 7.3%. OCT demonstrated LLE in 50.5% of lesions. The lesions with LLE had ...

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    22. The use of optical coherence tomography in diagnosis of HIV-associated atherosclerosis: Case report

      The use of optical coherence tomography in diagnosis of HIV-associated atherosclerosis: Case report

      Background and Aims: Patients with human immunodeficiency virus (HIV) are at higher risk for coronary artery disease, due to accelerated atherosclerosis resulting from chronic inflammation, the prevalence of cardiovascular risk factors and the side effects of highly active antiretroviral therapy (HAART). The atherosclerosis associated with HIV differs in important ways from atherosclerosis in the non-HIV setting. The present article aimed to report an unusual case of atherosclerosis in HIV-infected young women without any traditional cardiovascular risk factors on OCT.

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    23. Comparison of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol for the prediction of thin-cap fibroatheroma determined by intravascular optical coherence tomography

      Comparison of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol for the prediction of thin-cap fibroatheroma determined by intravascular optical coherence tomography

      Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/ HDL-C), total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) and thin-cap fibroatheroma has not yet been established. Methods It was a single center, retrospective observational study. In total, we recruited 421 patients (82.4% men; mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography (OCT). The thinnest-capped fibroatheroma (TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore ...

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