1. Articles in category: Cardiology

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    1. Is it safe to implant bioresorbable scaffolds in ostial side-branch lesions? Impact of ‘neo-carina’ formation on main-branch flow pattern. Longitudinal clinical observations

      Is it safe to implant bioresorbable scaffolds in ostial side-branch lesions? Impact of ‘neo-carina’ formation on main-branch flow pattern. Longitudinal clinical observations

      Formation of a ‘neo-carina’ has been reported after bioresorbable vascular scaffolds (BVS) implantation over side-branches. However, as this ‘neo-carina’ could protrude into the main-branch, its hemodynamic impact remains unknown. We present two cases of BVS implantation for ostial side-branch lesions, and investigate the flow patterns at follow-up and their potential impact. Computational fluid dynamics analysis was performed, using a 3D mesh created by fusion of 3-dimensional angiogram with optical coherence tomography images. In our first case, mild disturbances were seen when ‘neo-carina’ did not protrude perpendicularly into the main branch. In the second case, extensive flow re-distribution was observed due ...

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    2. Evaluation of IVOCT imaging of coronary artery metallic stents with neointimal coverage

      Evaluation of IVOCT imaging of coronary artery metallic stents with neointimal coverage

      Accuracy of IVOCT for measurement of neointimal thickness and effect of neointima in the appearance of metallic struts in IVOCT images was investigated. Phantom vessels were constructed and coronary stents were deployed and covered with thick (250–400 μm) and thin (30–70 μm) phantom neointima. High resolution Micro-CT images of the stent struts were recorded as a gold standard. IVOCT images of the phantom vessels were acquired with various luminal blood scattering strengths and measured neointimal thicknesses from IVOCT and Micro-CT images were compared. In transparent lumen, comparison of IVOCT and Micro-CT neointima thickness measurements found no significant difference ...

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    3. Scaffold and Edge Vascular Response Following Implantation of Everolimus-Eluting Bioresorbable Vascular Scaffold : A 3-Year Serial Optical Coherence Tomography Study

      Scaffold and Edge Vascular Response Following Implantation of Everolimus-Eluting Bioresorbable Vascular Scaffold : A 3-Year Serial Optical Coherence Tomography Study

      Objectives This study sought to investigate the in-scaffold vascular response (SVR) and edge vascular response (EVR) after implantation of an everolimus-eluting bioresorbable scaffold (BRS) using serial optical coherence tomography (OCT) imaging. Background Although studies using intravascular ultrasound have evaluated the EVR in metal stents and BRSs, there is a lack of OCT-based SVR and EVR assessment after BRS implantation. Methods In the ABSORB Cohort B (ABSORB Clinical Investigation, Cohort B) study, 23 patients (23 lesions) in Cohort B1 and 17 patients (18 lesions) in Cohort B2 underwent truly serial OCT examinations at 3 different time points (Cohort B1: post-procedure, 6 ...

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    4. Recanalized Thrombus Treated With Bioresorbable Vascular Scaffold Insights From Optical Coherence Tomography

      Recanalized Thrombus Treated With Bioresorbable Vascular Scaffold Insights From Optical Coherence Tomography

      A 29-year-old man underwent coronary angiography after non–ST-segment elevation myocardial infarction. He was a current smoker and did not have any other relevant medical history. Coronary angiography revealed a lesion with contrast filling defect and irregular lumen border at the mid-segment of the left anterior descending artery (Figure 1 ). Coronary distal flow was partially preserved. Optical coherence tomography (OCT) was performed to characterize the lesion. Lesion was crossed with a BMW Coronary guidewire (Abbott Vascular, Abbott Park, Illinois) and placed in the distal left anterior descending artery. An OCT catheter (C7-XR, Dragon Fly, LightLab, St. Jude Medical, St. Paul ...

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    5. Treatment of In-Stent Restenosis With Bioresorbable Vascular Scaffolds: Optical Coherence Tomography Insights

      Treatment of In-Stent Restenosis With Bioresorbable Vascular Scaffolds: Optical Coherence Tomography Insights

      The role of bioresorbable vascular scaffolds (BVS) in patients with in-stent restenosis (ISR) remains unsettled. We present optical coherence tomography (OCT) findings in a series of 15 consecutive patients undergoing treatment of ISR with BVS under systematic OCT guidance. OCT disclosed severe ISR in all patients (minimal lumen area (MLA) 1.3±0.6 mm 2 ; stent obstruction 80±10%). After the procedure OCT MLA was 6.4±2 mm 2 with a final BVS expansion of 79±19%. “ Angiographically silent” edge-dissections (n=6), intra-device-dissections (n=3), tissue prolapse (n=3) and malapposition (n=3) were also readily visualized. These ...

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      Mentions: Fernando Alfonso
    6. Suboptimal stent deployment is associated with subacute stent thrombosis: Optical Coherence Tomography insights from a multicenter matched study. From the CLI Foundation investigators: the CLI-THRO study

      Suboptimal stent deployment is associated with subacute stent thrombosis: Optical Coherence Tomography insights from a multicenter matched study. From the CLI Foundation investigators: the CLI-THRO study

      Background Acute or sub-acute stent thrombosis (ST) is a well described complication usually causing acute coronary syndromes (ACS) and in the worst case scenario sudden cardiac death. In this study we aimed at exploring the potential role of optical coherence tomography (OCT) in the understanding of the mechanism of ST. Methods Twenty-one consecutive patients, after ACS due to a definite sub-acute ST, were assessed with OCT and matched 1:2 with 42 patients undergoing OCT for scheduled follow-up. OCT assessment was focused on features indicative of non-optimal stent deployment: under-expansion, malapposition, edge dissection and reference lumen narrowing. Results OCT revealed ...

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    7. Trimodality imaging system and intravascular endoscopic probe: combined optical coherence tomography, fluorescence imaging and ultrasound imaging

      Trimodality imaging system and intravascular endoscopic probe: combined optical coherence tomography, fluorescence imaging and ultrasound imaging

      In this Letter, we present a trimodality imaging system and an intravascular endoscopic probe for the detection of early-stage atherosclerotic plaques. The integrated system is able to acquire optical coherence tomography (OCT), fluorescence, and ultrasound images and simultaneously display them in real time. A trimodality intravascular endoscopic probe of 1.2 mm in diameter and 7 mm in length was fabricated based on a dual-modality optical probe that integrates OCT and fluorescence imaging functions and a miniature ultrasound transducer. The probe is capable of rotating at up to 600 rpm. Ex vivo images from rabbit aorta and human coronary arteries ...

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    8. Multiple Simultaneous Plaque Erosion in 3 Coronary Arteries

      Multiple Simultaneous Plaque Erosion in 3 Coronary Arteries

      We performed optical coherence tomography (OCT) imaging with matched histology in a 34-year-old man with history of smoking and untreated hyperlipidemia who had suffered from epigastric pain and was found dead at home. Multiple plaque erosions in 3 major coronary arteries were discovered (Figure 1 )

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    9. Automatic quantification of intravascular optical coherence tomography (Thesis)

      Automatic quantification of intravascular optical coherence tomography (Thesis)

      As mentioned above, IVOCT, as a novel imaging modality, has played an active role in a wide range of CAD applications, including research and clinical routine. Due to its unparalleled high resolution and the ability to delineate complex vascular structures, IVOCT technology makes many precise measurement and novel applications possible. However, currently, a lot of analyses in IVOCT images are still relying on the manual work which decreases their value. The goal of this thesis is to develop robust and accurate (semi)automated methods that can detect and segment the interesting components in IVOCT pullback runs, such as implanted stent ...

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    10. Perspectives on Imaging the Left Main Coronary Artery Using Intravascular Ultrasound and Optical Coherence Tomography

      Perspectives on Imaging the Left Main Coronary Artery Using Intravascular Ultrasound and Optical Coherence Tomography

      Percutaneous Coronary Intervention (PCI) for significant left main coronary artery (LMCA) stenosis is increasingly being viewed as a viable alternative to Coronary Artery Bypass Grafting (CABG) (1). This is leading to an expectation of increasing numbers of such procedures, with a consequent focus on both the ability to image both lesion severity, and assess more accurately the results of PCI. While there have been advances in physiologic assessment of left main severity using fractional flow reserve (FFR), imaging of the LMCA using Intravascular Ultrasound (IVUS) and more recently Optical Coherence Tomography (OCT) has the specific advantage of being able to ...

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    11. Composition Imaging System for Intravascular Optical Coherence Tomography “Compovision-OCT”

      Composition Imaging System for Intravascular Optical Coherence Tomography “Compovision-OCT”

      We have developed an optical coherence tomography system, Compovision-OCT (CV-OCT) that detects lipid for intravascular diagnosis. This system is developed by combining our proprietary Compovision technology, which visualizes the composition of the object using near-infrared light, and optical coherence tomography, which visualizes the cross-sectional tomographic image of the object using interference of light. The main feature of CV-OCT is that it utilizes the near-infrared light in the 1.7 µm wavelength band, which shows an absorption peak of lipid contained in coronary artery plaque. To achieve a performance needed in clinical applications, this system employs a broadband light source based ...

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    12. Macrophages and intravascular optical coherence tomography bright spots: a quantitative study

      Macrophages and intravascular optical coherence tomography bright spots: a quantitative study

      Objectives We hypothesized that bright spots in intravascular optical coherence tomography (IVOCT) images may originate by co-localization of plaque materials of differing indices of refraction (IR). To quantitatively identify bright spots, we developed an algorithm that accounts for factors including tissue depth, distance from light source, and signal-to-noise ratio. We used this algorithm to perform a bright spot analysis of IVOCT images, and compared these results with histologic examination of matching tissue sections. Background Although bright spots are thought to represent macrophages in IVOCT images, studies of alternative etiologies have not been reported. Methods Fresh human coronary arteries (n=14 ...

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    13. Automatic lumen contour detection in intravascular OCT images using Otsu binarization and intensity curve

      Automatic lumen contour detection in intravascular OCT images using Otsu binarization and intensity curve

      This paper proposes an automatic method for the detection of lumen contours in intravascular OCT images with guide wire shadow artifacts. This algorithm is divided into five main procedures: pre-processing, an Otsu binarization approach, an intensity curve approach, a lumen contour position correction, and image reconstruction and contour extraction. The 30 IVOCT images from six anonymous patients were used to verify this method and we obtained 99.2% sensitivity and 99.7% specificity with this algorithm.

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    14. Automatic atherosclerotic heart disease detection in intracoronary optical coherence tomography images

      Automatic atherosclerotic heart disease detection in intracoronary optical coherence tomography images

      Intracoronary optical coherence tomography (OCT) is a new invasive imaging system which produces highresolution images of coronary arteries. Preliminary data suggests that the atherosclerotic disease can be detected from the intracoronary OCT images. However, manual assessment of the intracoronary OCT images is time-consuming and subjective. In this work, we present an automatic atherosclerotic disease detection system on intracoronary OCT images. In the system, a preprocessing scheme is first applied to remove speckle noise and artifacts caused by catheter. Intensity, Histograms of Oriented Gradients (HOG), and Local Binary Patterns (LBP) are then extracted to represent the OCT image. Finally a linear ...

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    15. Innovations in Microscopic Imaging of Atherosclerosis and Valvular Disease (Book Chapter)

      Innovations in Microscopic Imaging of Atherosclerosis and Valvular Disease (Book Chapter)

      Calcific aortic valve disease (CAVD) is still an unsolved medical problem, because the pathogenesis of CAVD is poorly understood and early calcification is hard to identify. The lack of high-resolution imaging tools to study early stage disease further hampers the search for therapeutic targets. Micro-optical coherence tomography (μOCT), which is a new form of OCT, is the highest-resolution cross-sectional OCT technology available today with 1 μm resolution. We used μOCT to visualize detailed cellular and subcellular structure associated with early calcific changes in diseased human and murine aortic valves. The results suggest that μOCT imaging has the potential to provide ...

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    16. Long-term invasive follow-up of the everolimus-eluting bioresorbable vascular scaffold: five-year results of multiple invasive imaging modalities

      Long-term invasive follow-up of the everolimus-eluting bioresorbable vascular scaffold: five-year results of multiple invasive imaging modalities

      Aims: The Paradise Ultrasound Renal Denervation System is a next-generation catheter-based device which was used to investigate whether the target ablation area can be controlled by changing ultrasound energy and duration to optimise nerve injury while preventing damage to the arterial wall. Methods and results: Five ultrasound doses were tested in a thermal gel model. Catheter-based ultrasound denervation was performed in 15 swine (29 renal arteries) to evaluate five different doses in vivo , and animals were euthanised at seven days for histopathologic assessment. In the gel model, the peak temperature was highest in the low power-long duration (LP-LD) dose, followed ...

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    17. New method to determine vessel healing after stent implantation

      New method to determine vessel healing after stent implantation

      Stent implantation is the most widely used method to treat patients with coronary heart disease. In spite of sophisticated contemporary technology and procedures the treatment is not without its risks. The most serious complication is a sudden re-blockage – called stent thrombosis – which can lead instantly to a heart attack. The risk of stent thrombosis is related to the degree (or lack) of healing in the weeks and months after stent implantation. Accordingly determination of the degree of healing surrounding the stent is crucial to evaluating this potential risk. Cardiologists in the PRESTIGE project have recently developed a new analytical method ...

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    18. Ex vivo 4D visualization of aortic valve dynamics in a murine model with optical coherence tomography

      Ex vivo 4D visualization of aortic valve dynamics in a murine model with optical coherence tomography

      The heart and its mechanical components, especially the heart valves and leaflets, are under enormous strain and undergo fatigue, which impinge upon cardiac output. The knowledge about changes of the dynamic behavior and the possibility of early stage diagnosis could lead to the development of new treatment strategies. Animal models are suited for the development and evaluation of new experimental approaches and therefor innovative imaging techniques are necessary. In this study, we present the time resolved visualization of healthy and calcified aortic valves in an ex vivo artificially stimulated heart model with 4D optical coherence tomography and high-speed video microscopy.

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    19. Stent Coverage and Neointimal Proliferation in Bare Metal Stents Postdilated With a Paclitaxel-Eluting Balloon Versus Everolimus-Eluting Stents: Prospective Randomized Study Using Optical Coherence Tomography at 6-Month Follow-Up

      Stent Coverage and Neointimal Proliferation in Bare Metal Stents Postdilated With a Paclitaxel-Eluting Balloon Versus Everolimus-Eluting Stents: Prospective Randomized Study Using Optical Coherence Tomography at 6-Month Follow-Up

      B a ckground— In this randomized tri a l, strut coverage and neointimal proliferation of a ther a py of bare metal stents (BMSs) postdilated with the p a clit a xel drug-elut in g balloon (DEB) w a s comp a red with everolimus drug-elut in g stents (DESs) at 6-month follow-up using optical coherence tomography . We hypothesized sufficient stent coverage at follow-up . Methods and Results— A tot a l of 105 lesions in 90 p at ients were tre at ed with either XIENCE V DES (n=51) or BMS postdilated with the SeQuent Ple a se DEB ...

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    20. Instant stent-accentuated three-dimensional optical coherence tomography of a true bifurcation lesion treated with culotte stenting

      Instant stent-accentuated three-dimensional optical coherence tomography of a true bifurcation lesion treated with culotte stenting

      A 65-year-old woman was performed percutaneous coronary intervention for a bifurcation lesion of the left anterior descending artery (LAD) and the first diagonal branch (Dg). After pre-dilatation, the proximal LAD-Dg was stented with the platinum-chromium elevolimus-eluting stent (PtCrEES). After rewiring to LAD, the instant stent-accentuated 3-dimensional optical coherence tomography (iSA3D-OCT) was reconstructed from 2-dimensional OCT (2D-OCT) by ImageJ with self-made macro-program. Classification of overhanging struts in front of the side branch (SB) ostium was the connecting to carina type, and the recrossed wire was confirmed to pass through the large distal cell. After kissing balloon dilatation (KBD), the mid-distal LAD ...

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    21. Novel OCT Flushing Technique for Complex Scenarios: Imaging During Iatrogenic Transient AV Block Induced by Intracoronary Adenosine

      Novel OCT Flushing Technique for Complex Scenarios: Imaging During Iatrogenic Transient AV Block Induced by Intracoronary Adenosine

      We report the application of a novel optical coherence tomography (OCT) flushing technique where OCT run was performed during transient complete atrioventricular block induced by intracoronary bolus of adenosine. This technique may allow lower hydraulic force needed for contrast flush and reduce artifacts, with consequently improved OCT imaging in demanding clinical scenarios.

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    22. Neointimal coverage of zotarolimus-eluting stent at 1, 2, and 3 months' follow-up: an optical coherence tomography study

      Neointimal coverage of zotarolimus-eluting stent at 1, 2, and 3 months' follow-up: an optical coherence tomography study

      Incomplete neointimal coverage and malapposed struts after stenting are associated with increased risk of stent thrombosis. We aimed to evaluate neointimal coverage early after Resolute zotarolimus-eluting stent (R-ZES) implantation using optical coherence tomography (OCT). A total of 20 patients with de novo native coronary lesions with R-ZES were enrolled. Among these patients, 20 stented lesions in 19 patients were evaluated at 1, 2, and 3 months after R-ZES implantation. The strut apposition and neointimal coverage were evaluated by OCT. Neointimal hyperplasia (NIH) thickness and percentage of covered struts and the proportion of incompletely apposed struts were measured at 1-mm intervals ...

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    23. Three-vessel coronary artery disease evaluation by multimodality imaging with Near-Infrared Spectroscopy (NIRS) plus Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT)

      Three-vessel coronary artery disease evaluation by multimodality imaging with Near-Infrared Spectroscopy (NIRS) plus Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT)

      There is a rapid evolution in hybrid intravascular imaging for identifying high-risk biological and structural coronary arterial plaques in vivo and searching the missing pieces of the complex puzzle that determine the pathophysiology of myocardial infarction [1].

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    24. Are the findings of optical coherence tomography sufficient for the evaluation of the safety and efficacy of the next generation of drug eluting stents

      Are the findings of optical coherence tomography sufficient for the evaluation of the safety and efficacy of the next generation of drug eluting stents

      The cr8 stent is a next generation drug eluting stent (DES) with a polymer free abluminal reservoir drug release system. It uses an organic fatty acid permeation enhancer and a carbon surface to increase biocompatibility. The fatty acid enhancer may have beneficial effect in improving drug delivery in diabetic patient where neointimal hyperplasia is particularly problematic[1]. These types of design features are exciting new developments and may provide novel strategies for improving the safety and efficacy of the next generation of coronary stents.

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